State law (Public Act 96-0940) requires HFS to issue annual medical cards instead of monthly medical cards. The cards will not contain beginning and end dates; therefore, the new medical cards will not guarantee eligibility or payment for medical services for a specified time period. Medical providers must always verify the person's identity and eligibility for coverage for each date of service.

Features of the New HFS Medical Card

The monthly medical cards (Forms HFS 469, 469KC and 469HW) are being replaced by a revised Form HFS 469, HFS Medical Card. The terms 'MediPlan' and 'All Kids/FamilyCare/Moms & Babies Identification Cards' will be replaced with 'HFS Medical Card' when the affected pages are updated.

After initial implementation, medical cards will be issued only in the following situations:

a medical case is approved,

a person(s) is added to or deleted from the medical case,

a REDE or renewal is processed (starting 6 months after initial implementation),

a person's name or date of birth is corrected on a medical case, and

a duplicate card is processed at the client's request.

The annual HFS Medical Cards will no longer display program or case specific informational messages, such as co-pay messages, restriction messages or managed care messages. This information is included on other notices sent to the client at approval or when changes occur. Clients can also confirm this information by calling the new Customer Automated Voice Response System that is described below.

Initial Implementation

Effective March 2013, an annual HFS Medical Card (revised HFS 469) will be issued to all clients who qualify for a medical card, including clients who formerly received the 469KC. In addition to the cases that would have been issued a card via the regular schedule, medical cards will be sent to all active spenddown cases, whether in met or unmet status.

The new cards will be sent using the same mailing schedule that would have been used for the March 2013 monthly cards. After the revised HFS 469s have been issued to all active medical cases, monthly cards that were generated based on the regular authorization schedule will no longer be produced.

Illinois Healthy Women (Pink Cards)

IHW cards (469HW) will not be replaced at initial implementation for existing cases. Instead, the new medical cards will be issued to currently active IHW cases at their next renewal. This means that after implementation, some IHW clients will still use the pink IHW cards, while others will have the new annual cards.

After initial implementation, IHW cases that are approved due to prior medical benefits being closed, will get a new card at their next renewal. New IHW cases for women who were not on a prior medical case will get a medical card at approval.

Ongoing Card Issuance

The type actions that generate mercury cards are updated. Most medical cards that are generated based on the mercury schedule will continue to be generated.

NOTE: Since active medical cases will be issued a new annual HFS Medical Card at initial implementation, the issuance of cards based on REDEs/renewals will not begin until six months after initial implementation (other than IHW cases). This will prevent duplicate issuances of thousands of cards and brochures in the first six months after implementation.

Type Actions for which a medical card will continue to be generated:

TA

Action

TAR

Reason

10

Approve and cancel

45, 47, 49

MPE approval

10

Approve and cancel

81

postpartum woman or deceased or adopted child

10

Approve and cancel

B9

noncitizen pregnant woman

10

Approve and cancel

F2

IHW approval when woman was not on prior medical case

10

Approve and cancel

C3 & C4

IHW renewal

11

New approval

12

Reapplication approval

any except TAR 98

All reapplications other than 'quick reinstatements'

15

Resumption with a new payee

34

Change in unit members

39

Actions on a canceled case

with TAR 36 only

used to add a person for medical to a canceled or medical extension case

40

Transfer-in of active case

only when a payee's name in Item 8 is changed or corrected

42

Transfer between category 04 & 06 or 94 & 96

only when a person is added or deleted from the case with this TA

55

Replace medical card

with TAR 03 or with no TAR

used to replace a card

Additional Type Action for which a medical card should be generated:

TA

Action

TAR

Reason

30

Continuing eligibility

REDEs & renewals

31

Change or correction of information

when the name is changed or corrected for a person on a medical case, or for the payee of a medical case; or when the REDE date in Item 30 is changed

31

Change or correction of information

71

when premiums are paid on an enrolled All Kids Share or Premium case and the system changes the case from enrolled to active status

used to change information on a canceled case; issue a new card only with TAR 36 used to add a person on a canceled case for medical

40

Transfer-in of active case

do not issue a card in situations other than name change

41

Transfer-in and resume

used to transfer-in and resume a suspended case and there is no change in payee

42

Transfer between Cat 04 and 06 or 94 and 96

do not issue a card in situations other than deletion or addition of a person

55

Issue one-month medical card

with TAR 95, 96 or 97

used to issue a card when monthly spenddown is met

Replacing an HFS Medical Card

When a client reports that their HFS Medical Card is lost or was not received, staff can issue a replacement using TA 55 in the same way that monthly medical cards were replaced (see WAG 22-02-01). Replacement cards are centrally mailed. Clients may request a replacement by contacting their DHS or HFS worker, or by calling the DHS Customer Help Line or the HFS Health Benefits Hotline. Whoever gets the call should take the action.

Medical providers must always verify a person's eligibility prior to providing medical services whether or not the client is able to present a medical card. If the client does not have their HFS Medical Card, but has another form of identification and can provide their medical card ID number (also called Recipient Identification Number or RIN), or can give their social security number and date of birth, providers can verify eligibility by checking:

The Medical Electronic Data Interchange (MEDI) internet site, or

the Recipient Eligibility Verification (REV) system, or

calling the provider Automated Voice Response System (AVRS).

It is important to let clients know that, if they are eligible for HFS covered medical services, medical providers can provide services to them even if they do not have their medical card with them.

"Temporary MediPlan Card" Option Revised to "Interim Eligibility"

Temporary medical cards will no longer be issued. The Automated Temporary MediPlan Card (ATMC) system (WinGrape Option F7) was used to issue a temporary medical card and automatically update the Interim Recipient Data Base (IRDB). With the implementation of the semi-permanent medical card, the system will no longer generate the temporary medical card (Form 1411CF) and notice (Form 1411A).

The ability for staff to update the IRDB system vis Option F7 remains intact. Updating the IRDB allows medical providers to verify a client's medical eligibility and submit claims for payment the same day the service is given. This is necessary because it takes 4 or 5 workdays for new or updated medical eligibility information entered by the FCRC or All Kids Unit to be posted to MMIS and to become accessible to providers through the Electronic Claims Processing system. As a result, providers may deny medical services to a client because medical eligibility has not yet been posted to MMIS.

WinGrape Option F7 is renamed from "Temporary MediPlan Card" to "Interim Eligibility". The Interim Eligibility screen is revised to keep only the reason codes that update the Interim Recipient Data Base (IRDB). Entries to this screen will update the IRDB when:

the case is new or reinstated and less than 11 days old, or

a person was added to the medical benefit unit within the past 10 days, or

spenddown was met.

Reminder: As with the ATMC system, the Interim Eligibility System does not update the eligibility files on the Client Database (CDB) or Recipient Database (RDB). Continue to process updates to these systems as you normally do.

New Customer Automated Voice Response System (AVRS)

The annual HFS Medical Card contains a toll-free number (1-855-828-4995) for clients to call to verify their own, or a family member's, eligibility. The number connects to an Automated Voice Response System. Clients will need to enter the 9-digit HFS Medical Card identification number (also know as the RIN number) of the person for whom they are checking eligibility.

Since the annual HFS Medical Cards do not guarantee eligibility for a specific time period, customers may need to verify their eligibility for services prior to seeing a provider or filling a prescription. This is especially important for spenddown clients who are used to receiving a medical card only for periods in which spenddown is met. They will have to rely more on notices of decision and notices of spenddown met.